Method of inhibiting constitutively active phosphorylated FLT3 kinase

ABSTRACT

The present invention includes a method of inhibiting or reducing deregulated FLT3 tyrosine kinase activity or FLT3 tyrosine kinase expression in a subject with a proliferative disease by administering to the subject having or suspected to have the proliferative disease, a therapeutically or prophylactically effective amount of the compound of Formula I: 
                         
or pharmaceutically acceptable salt thereof.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.15/715,219, filed Sep. 26, 2017, which is a continuation of U.S. patentapplication Ser. No. 14/671,613, filed Mar. 27, 2015, now U.S. Pat. No.9,801,869 issued Oct. 31, 2017, which is a continuation of U.S. patentapplication Ser. No. 14/026,778, filed Sep. 13, 2013, now U.S. Pat. No.9,023,880 issued May 5, 2015, which claims priority to U.S. ProvisionalApplication Ser. No. 61/704,053, filed Sep. 21, 2012, the entirecontents of which are incorporated herein by reference.

TECHNICAL FIELD OF THE INVENTION

The present invention relates to methods of reducing or inhibiting thekinase activity of normal and mutated FLT3 in a cell or a subject, andthe use of such methods for preventing or treating cell proliferativedisorder (s) related to FLT3.

STATEMENT OF FEDERALLY FUNDED RESEARCH

Not Applicable.

INCORPORATION-BY-REFERENCE OF MATERIALS FILED ON COMPACT DISC

Not Applicable.

BACKGROUND OF THE INVENTION

Without limiting the scope of the invention, its background is describedin connection with protein kinases.

Protein kinases are enzymes that chemically modify other proteins bycatalyzing the transfer of gamma phosphates from nucleotidetriphosphates, often adenosine triphosphate (ATP), and covalentlyattaching them to a free hydroxyl group of amino acid residues serine,threonine and tyrosine.

Approximately 30% of all human proteins may be modified by kinaseactivity. Protein kinases direct the enzymatic activity, cellularlocation and primary function/association of substrate proteins andregulate cell signal transduction and cell function coordination.

Research studies have shown that aberrant expression of normal ormutated protein kinases are frequently associated with the formation andpropagation of a number of diseases. Studies have shown thatoverexpression or inappropriate protein kinase expression is associatedwith cancer, cardiovascular disease, rheumatoid arthritis, diabetes,ocular disease, neurologic disorders and autoimmune disease. Thus,investigating compounds that potently inhibit the activity and functionof protein kinases will allow for a greater understanding of thephysiological roles of protein kinases.

The FMS-like tyrosine kinase 3 (FLT3) gene encodes a membrane boundreceptor tyrosine kinase that affects hematopoiesis leading tohematological disorders and malignancies. See Drexler, HG et al.Expression of FLT3 receptor and response to FLT3 ligand by leukemiccells. Leukemia. 1996; 10:588-599; Gilliland, D G and J D Griffin. Theroles of FLT3 in hematopoiesis and leukemia. Blood. 2002; 100:1532-1542;Stirewalt, D L and J P Radich. The role of FLT3 in hematopoieticmalignancies. Nat Rev Cancer. 2003; 3:650-665. Activation of FLT3receptor tyrosine kinases is initiated through the binding of the FLT3ligand (FLT3L) to the FLT3 receptor, also known as Stem cell tyrosinekinase-1(STK-1) and fetal liver kinase-2 (flk-2), which is expressed onhematopoietic progenitor and stem cells.

FLT3 is one of the most frequently mutated genes in hematologicalmalignancies, present in approximately 30% of adult acute myeloidleukemia (AML). See Nakao M, S Yokota and T Iwai.Internal tandemduplication of the FLT3 gene found in acute myeloid leukemia. Leukemia.1996; 10:1911-1918; H Kiyoi, M Towatari and S Yokota. Internal Tandemduplication of the FLT3 gene is a novel modality of elongation mutation,which causes constitutive activation of the product. Leukemia.1998;12:1333-1337; P D Kottaridis, R E Gale, et al. The presence of a FLT3internal tandem duplication in patients with acute myeloid leukemia(AML) adds important prognostic information to cytogenetic risk groupand response to the first cycle of chemotherapy: analysis of 854patients from the United Kingdom Medical Research Council AML 10 and 12trials. Blood. 2001; 98:1742-1759; Yamamoto Y, Kiyoi H, Nakano Y.Activating mutation of D835 within the activation loop of FLT3 in humanhematologic malignancies. Blood. 2001; 97:2434-2439; Thiede C, CSteudel, Mohr B. Analysis of FLT3-activating mutations in 979 patientswith acute myelogenous leukemia: association with FAB subtypes andidentification of subgroups with poor prognosis. Blood. 2002;99:4326-4335. FLT3 mutations have been detected in approximately 2% ofpatients diagnosed with intermediate and high risk myelodysplasticsyndrome (MDS). See S Bains, Luthra R, Medeiros L J and Zuo Z. FLT3 andNPM1 mutations in myelodysplastic syndromes: Frequency and potentialvalue for predicting progression to acute myeloid leukemia. AmericanJournal of Clinical Pathology. January 2011; 135:62-69;P K Bhamidipati,Daver N G, Kantarjian H, et al. FLT3 mutations in myelodysplasticsyndromes(MDS) and chronic myelomonocytic leukemia (CMML). 2012. Journalof Clinical Oncology. Suppl; abstract 6597. Like MDS, the number of FLT3mutations in patients with acute promyelocytic leukemia (APL) is small.The most common FLT3 mutations are internal tandem duplications (ITDs)that lead to in-frame insertions within the juxtamembrane domain of theFLT3 receptor. FLT3-ITD mutations have been reported in 15-35% of adultAML patients. See Nakao M, S Yokota and T Iwai. Internal tandemduplication of the FLT3 gene found in acute myeloid leukemia. Leukemia.1996; 10:1911-1918; H Kiyoi, M Towatari and S Yokota. Internal Tandemduplication of the FLT3 gene is a novel modality of elongation mutation,which causes constitutive activation of the product. Leukemia.1998;12:1333-1337; H Kiyoi, T Naoe and S Yokota. Internal tandem duplicationof FLT3 associated with leukocytosis in acute promyelocytic leukemia.Leukemia Study Group of the Ministry of Health and Welfare (Kohseisho).Leukemia.1997; 11:1447-1452; S Schnittger, C Schoch and M Duga. Analysisof FLT3 length mutations in 1003 patients with acute myeloid leukemia:correlation to cytogenetics, FAB subtype, and prognosis in the AMLCGstudy and usefulness as a marker for the detection of minimal residualdisease. Blood. 2002; 100:59-66. A FLT3-ITD mutation is an independentpredictor of poor patient prognosis and is associated with increasedrelapse risk after standard chemotherapy, and decreased disease free andoverall survival. See FM Abu-Duhier, Goodeve A C, Wilson G A, et al.FLT3 internal tandem duplication mutations in adult acute myeloidleukemia define a high risk group. British Journal of Hematology. 2000;111:190-195; H Kiyoi, T Naoe, Y Nakano, et al. Prognostic implication ofFLT3 and N-RAS gene mutations in acute myeloid leukemia. Blood. 1999;93:3074-3080. Less frequent are FLT3 point mutations that arise in theactivation loop of the FLT3 receptor. The most commonly affected codonis aspartate 835 (D835). Nucleotide substitutions of the D835 residueoccur in approximately 5-10% of adult acute myeloid leukemia patients.See D L Stirewalt and J P Radich. The role of FLT3 in haematopoieticmalignancies. Nature Reviews Cancer. 2003; 3:650-665;Y Yamamoto, H Kiyoiand Y Nakano, et al. Activating mutation of D835 within the activationloop of FLT3 in human hematologic malignancies. Blood. 2001;97:2434-2439; C Thiede, Steudal C, Mohr B, et al. Analysis ofFLT3-activating mutations in 979 patients with acute myelogenousleukemia: association with FAB subtypes and identification of subgroupswith poor prognosis. Blood. 2002; 99:4326-4335;U Bacher, Haferlach C, WKern, et al. Prognostic relevance of FLT3-TKD mutations in AML: thecombination matters-an analysis of 3082 patients. Blood. 2008;111:2527-2537.

The heightened frequency of constitutively activated mutant FLT3 inadult AML has made the FLT3 gene a highly attractive drug target in thistumor type. Several FLT3 inhibitors with varying degrees of potency andselectivity for the target have been or are currently being investigatedand examined in AML patients. See T Kindler, Lipka D B, and Fischer T.FLT3 as a therapeutic target in AML: still challenging after all theseyears. Blood.2010; 116:5089-102.

FLT3 kinase inhibitors known in the art include Lestaurtinib (also knownas CEP 701, formerly KT-555, Kyowa Hakko, licensed to Cephalon);CHIR-258 (Chiron Corp.); EB10 and IMC-EB10 (ImClone Systems Inc.);Midostaurin (also known as PKC412, Novartis AG); Tandutinib (also knownas MLN-518, formerly CT53518, COR Therapeutics Inc., licensed toMillennium Pharmaceuticals Inc.); Sunitinib (also known as SU11248,Pfizer USA); Quizartinib (also known as AC220, Ambit Biosciences); XL999 (Exelixis USA, licensed to Symphony Evolution, Inc.); GTP 14564(Merck Biosciences UK); AG1295 and AG1296; CEP-5214 and CEP-7055(Cephalon). The following PCT International Applications and U.S. patentapplications disclose additional kinase modulators, including modulatorsof FLT3: WO 2002/032861, WO 2002/092599, WO 2003/035009, WO 2003/024931,WO 2003/037347, WO 2003/057690, WO 2003/099771, WO 2004/005281, WO2004/016597, WO 2004/018419, WO 2004/039782, WO 2004/043389, WO2004/046120, WO 2004/058749, WO 2004/058749, WO 2003/024969 and U.SPatent Application Publication No. 2004/0049032. See also Levis M, K FTse, et al. 2001 “A FLT3 tyrosine kinase inhibitor is selectivelycytotoxic to acute myeloid leukemia blasts harboring FLT3 internaltandem duplication mutations.” Blood 98(3): 885-887; Tse K F, et al.,Inhibition of FLT3-mediated transformation by use of a tyrosine kinaseinhibitor. Leukemia. July 2001; 15 (7): 1001-1010; Smith, B. Douglas etal., Singlet agent CEP-701, a novel FLT3 inhibitor, shows biologic andclinical activity in patients with relapsed or refractory acute myeloidleukemia Blood, May 2004; 103: 3669-3676; Griswold, Ian J. et al.,Effects of MLN518, A Dual FLT3 and KIT Inhibitor, on Normal andMalignant Hematopoiesis. Blood, Nov 2004; 104 (9): 2912-2918 [Epub aheadof print Jul 8]; Yee, Kevin W. H. et al., SU5416 and SU5614 inhibitkinase activity of wild-type and mutant FLT3 receptor tyrosine kinase.Blood, Oct 2002; 100(8): 2941-2949. O′Farrell, Anne-Marie et al.,SU11248 is a novel FLT3 tyrosine kinase inhibitor with potent activityin vitro and in vivo. Blood, May 2003; 101(9): 3597-3605; Stone, R. M etal., PKC-412 FLT3 inhibitor therapy in AML: results of a phase IItrials. Ann. Hematol. 2004; 83 Suppl 1:S89-90; and Murata, K. et al.,Selective cytotoxic mechanism of GTP-14564, a novel tyrosine kinaseinhibitor in leukemia cells expressing a constitutively active Fms-liketyrosine kinase 3 (FLT3). J Biol Chem. Aug. 29, 2003; 278 (35):32892-32898 [Epub 2003 Jun. 18]; Levis, Mark et al., Small Molecule FLT3Tyrosine Kinase Inhibitors. Current Pharmaceutical Design, 2004, 10,1183-1193.

FLT3 inhibitors are classified as Type I or Type II inhibitors. Thesetwo classifications are distinguished based on their relative affinitiesand mechanism of binding to phosphorylated and non-phosphorylatedreceptor sites. Type I inhibitors recognize the active conformation ofkinases. This conformation is conducive to phosphotransfer. Type Iinhibitors are generally composed of a heterocyclic ring system. SeeLiu, Y and N Gray. Rational design of inhibitors that bind to inactivekinase conformations. Nature Chem. Biol. 2006; 2:358-354. Examples ofType I FLT3 inhbitiors include Crenolanib besylate and Midostaurin. SeeMuralidhara C, Ramachandran A, Jain V. Crenolanib, a novel type I,mutant-specific inhibitor of class III receptor tyrosine kinases,preferentially binds to phosphorylated kinases. Cancer Research. 2012;72 (8 Supplement): 3683; J Cools, et al. Prediction of resistance tosmall molecule FLT3 inhibitors: implications for molecularly targetedtherapy of acute leukemia. Cancer Res. 2004; 64:6385-6389. Resistantmutations that render the kinase of the receptor tyrosine kinaseconstitutively phosphorylated could potentially be sensitive to type Iinhibitors that have greater affinity for the phosphorylated kinase.

By contrast, Type II inhibitors prefer to bind to the inactiveconformation of kinases. This conformation is typically referred to as‘DFG-out’ owing to the rearrangement of the motif. See J Zhang, Yang PL,and Gray NS. Targeting cancer with small molecule kinase inhibitors.Nature Reviews Cancer.2009; 9:28-39. Inhibitors such as imatinib,sorafenib and nilotinib bind in the type II conformation. See P WManley, Cowan-Jacob S W, Mestan J. Advances in the structural biology,design and clinical development of Bcr-Abl kinase inhibitors for thetreatment of chronic myeloid leukaemia. Biochim. Biophis. Acta. 2005;1754:3-13; PT Wan, et al. Mechanism of activation of the RAF-ERKsignaling pathway by oncogenic mutations of B-RAF. Cell. 2004;116:855-867. Resistant mutations to Type II inhibitors are mutationsthat render the kinase domain of the receptor tyrosine kinaseconstitutively phosphorylated. Type I inhibitors that target thephosphorylated kinase can overcome the resistance resulting from thetreatment with Type II inhibitors, and therefore have potential use intreating diseases that harbor these resistance mutations.

SUMMARY OF THE INVENTION

The present invention includes a method of inhibiting or reducingderegulated FLT3 tyrosine kinase activity or expression in a subjectwith a proliferative disease which comprises administering to thesubject having or suspected to have the proliferative disease, atherapeutically or prophylactically effective amount of the compound ofFormula I:

or a pharmaceutically acceptable salt or solvate thereof. In one aspect,the proliferative disease is selected from at least one of a leukemia,myeloma, myeloproliferative disease, myelodysplastic syndrome,idiopathic hypereosinophilic syndrome (HES), bladder cancer, breastcancer, cervical cancer, CNS cancer, colon cancer, esophageal cancer,head and neck cancer, liver cancer, lung cancer, nasopharyngeal cancer,neuroendocrine cancer, ovarian cancer, pancreatic cancer, prostatecancer, renal cancer, salivary gland cancer, small cell lung cancer,skin cancer, stomach cancer, testicular cancer, thyroid cancer, uterinecancer, and hematologic malignancy. In another aspect, thetherapeutically and prophylactically effective amounts are from about 15to 500 mg per day. In another aspect, the compound is administered atleast one of continuously, intermittently, systemically, or locally. Inanother aspect, the deregulated FLT3 is defined further as a mutatedFLT3 is constitutively active. In another aspect, the compound isadministered orally, intravenously, or intraperitoneally. In anotheraspect, the Crenolanib is Crenolanib Besylate, Crenolanib Phosphate,Crenolanib Lactate, Crenolanib Hydrochloride, Crenolanib Citrate,Crenolanib Acetate, Crenolanib Toluenesulphonate and CrenolanibSuccinate. In another aspect, the FLT3 is at least one of FLT3-ITD orFLT3-TKD. In another aspect, the therapeutically or prophylacticallyeffective amount of the compound is administered daily for as long asthe subject is in need of treatment for the proliferative disease. Inanother aspect, the composition is provided at least one of sequentiallyor concomitantly, with another pharmaceutical agent in a newly diagnosedproliferative disease subject, to maintain remission, or arelapsed/refractory proliferative disease subject. In another aspect,the compound is provided as a single agent or in combination withanother pharmaceutical agent in a newly diagnosed proliferative diseasesubject, to maintain remission, or a relapsed/refractory proliferativedisease subject. In another aspect, the compound is provided as a singleagent or in combination with another pharmaceutical agent in a newlydiagnosed proliferative disease pediatric subject, to maintainremission, or a relapsed/refractory proliferative disease pediatricsubject. In another aspect, the subject is relapsed/refractory to priorFLT3 tyrosine kinase inhibition. In another aspect, the furthercomprises the step of determining if the subject is relapsed/refractoryto a prior FLT3 tyrosine kinase inhibitor prior to providing the subjectwith treatment.

In another embodiment, the present invention includes a method fortreating a subject with a proliferative disease comprising:administering to the subject in need of such treatment a therapeuticallyeffective amount of Crenolanib or a salt thereof, wherein the cellproliferative disorder is characterized by deregulated FLT3 receptortyrosine kinase activity, proliferative disease is selected from atleast one of a leukemia, myeloma, myeloproliferative disease,myelodysplastic syndrome, idiopathic hypereosinophilic syndrome (HES),bladder cancer, breast cancer, cervical cancer, CNS cancer, coloncancer, esophageal cancer, head and neck cancer, liver cancer, lungcancer, nasopharyngeal cancer, neuroendocrine cancer, ovarian cancer,pancreatic cancer, prostate cancer, renal cancer, salivary gland cancer,small cell lung cancer, skin cancer, stomach cancer, testicular cancer,thyroid cancer, uterine cancer, and hematologic malignancy. In oneaspect, the compound is administered orally, intravenously, orintraperitoneally. In another aspect, the Crenolanib is CrenolanibBesylate, Crenolanib Phosphate, Crenolanib Lactate, CrenolanibHydrochloride, Crenolanib Citrate, Crenolanib Acetate, CrenolanibToluenesulphonate and Crenolanib Succinate. In another aspect, the FLT3is at least one of FLT3-ITD or FLT3-TKD. In another aspect, theCrenolanib is provided at least one of sequentially or concomitantly,with chemotherapy, radiotherapy, or surgery in a newly diagnosedproliferative disease, to maintain remission, or a relapsed/refractoryproliferative disease. In another aspect, the Crenolanib is provided asa single agent or in combination with chemotherapy, radiotherapy orsurgery for treatment of a pediatric subject with the proliferativedisease. In another aspect, the Crenolanib is provided as a single agentto at least one of post standard induction therapy, or high doseinduction therapy, in newly diagnosed proliferative disease. In anotheraspect, the Crenolanib is provided as a single agent in treatment ofsubjects with the proliferative disease that is either refractory to, orhas relapsed after, standard or high dose chemotherapy, radiotherapy orsurgery. In another aspect, the subject is relapsed/refractory to atleast one other tyrosine kinase inhibitor, including but not limited tosorafenib, quizartinib, PLX3397, sunitinib, Midostaurin, orLestaurtinib.

Yet another embodiment of the present invention includes a method fortreating a subject suffering from leukemia comprising: obtaining asample from the subject suspected of having a leukemia; determining fromthe subject sample that the subject has a deregulated FLT3 receptortyrosine kinase; and administering to the subject in need of suchtreatment a therapeutically effective amount of Crenolanib or a saltthereof, wherein the leukemia is characterized by deregulated FLT3receptor tyrosine kinase activity.

Another embodiment of the present invention includes a method forspecifically inhibiting a deregulated receptor tyrosine kinasecomprising: obtaining a subject sample and determining which receptortyrosine kinases are deregulated; and administering to a mammal in needof such treatment a therapeutically effective amount of Crenolanib or asalt thereof, wherein the deregulated receptor tyrosine kinase is a FLT3receptor tyrosine kinase. In one aspect, the proliferative disease isselected from at least one of a leukemia, myeloma, myeloproliferativedisease, myelodysplastic syndrome, idiopathic hypereosinophilic syndrome(HES), bladder cancer, breast cancer, cervical cancer, CNS cancer, coloncancer, esophageal cancer, head and neck cancer, liver cancer, lungcancer, nasopharyngeal cancer, neuroendocrine cancer, ovarian cancer,pancreatic cancer, prostate cancer, renal cancer, salivary gland cancer,small cell lung cancer, skin cancer, stomach cancer, testicular cancer,thyroid cancer, uterine cancer, and hematologic malignancy. In anotheraspect, the therapeutically and prophylactically effective amounts arefrom about 15 to 500 mg per day. In another aspect, the compound isadministered at least one of continuously, intermittently, systemically,or locally. In another aspect, the deregulated FLT3 is defined furtheras a mutated FLT3 is constitutively active. In another aspect, thecompound is administered orally, intravenously, or intraperitoneally. Inanother aspect, the Crenolanib is Crenolanib Besylate, CrenolanibPhosphate, Crenolanib Lactate, Crenolanib Hydrochloride, CrenolanibCitrate, Crenolanib Acetate, Crenolanib Toluenesulphonate and CrenolanibSuccinate. In another aspect, the FLT3 is at least one of FLT3-ITD orFLT3-TKD. In another aspect, the therapeutically or prophylacticallyeffective amount of the compound is administered daily for as long asthe subject is in need of treatment for the proliferative disease. Inone aspect, the subject is provided treatment, one or more subjectsamples are obtained to determine the effect of the treatment, andtreatment is continued until the proliferative disease is reduced oreliminated. In another aspect, the compound is provided at least one ofsequentially or concomitantly, with another pharmaceutical agent in anewly diagnosed proliferative disease subject, to maintain remission ofan existing subject, or a relapsed/refractory proliferative diseasesubject. In another aspect, the present invention is provided as asingle agent or in combination with another pharmaceutical agent in anewly diagnosed proliferative disease subject, to maintain remission, ora relapsed/refractory proliferative disease subject. In another aspect,the present invention is provided as a single agent or in combinationwith another pharmaceutical agent in a newly diagnosed proliferativedisease pediatric subject, to maintain remission, or arelapsed/refractory proliferative disease pediatric subject. In anotheraspect, the subject is relapsed/refractory to a prior FLT3 tyrosinekinase inhibitor.

Yet another embodiment of the present invention includes a method fortreating a subject with cancer comprising: obtaining a sample suspectedof having cancer from the subject; determining if the subject that hasbecome resistant to prior FLT3 protein tyrosine kinase inhibition; andadministering a therapeutically effective amount of Crenolanib or a saltthereof to overcome the resistance to the prior FLT3 protein tyrosinekinase inhibition. The present invention provides methods of reducing orinhibiting the kinase activity of FLT3 in a cell or a subject, and theuse of such methods for preventing or treating cell proliferativedisorder (s) related to FLT3. Other features and advantages of theinvention will be apparent from the following detailed description ofthe invention and from the claims.

BRIEF DESCRIPTION OF THE DRAWINGS

For a more complete understanding of the features and advantages of thepresent invention, reference is now made to the detailed description ofthe invention along with the accompanying figure in which:

FIGS. 1A to 1D show the affinity of the besylate salt of the presentinvention for the non-phosphorylated and phosphorylated states of ABL1and ABL (T3151); (FIG. 1A): shows replicates of a first (left) and asecond (right) standard dose-response curve for non-phosphorylated ABL1;(FIG. 1B): shows replicates of a first (left) and a second (right)standard dose-response curve for phosphorylated ABL1; (FIG. 1C): showsreplicates of a first (left) and a second (right) standard dose-responsecurve for non-phosphorylated ABL(T315I); (FIG. 1D): shows replicates ofa first (left) and a second (right) standard dose-response curve forphosphorylated ABL(T315I). The amount of kinase measured by qPCR(signal; y-axis) is plotted against the corresponding crenolanibconcentration in nanomolar in log10 scale (x-axis). Data points markedwith an “x” were not used for Kd determination.

FIGS. 2A and 2B show the affinity of the besylate salt of the presentinvention for the non-autoinhibited and autoinhibited states of FLT3;(FIG. 2A): shows replicates of a first (left) and a second (right)standard dose-response curves for non-autoinhibited state of FLT3; (FIG.2B): shows replicates of a first (left) and a second (right) standarddose-response curves for autoinhibited state of FLT3. The amount ofkinase measured by qPCR (signal; y-axis) is plotted against thecorresponding crenolanib concentration in nanomolar in log10 scale(x-axis). Data points marked with an “x” were not used for Kddetermination.

FIG. 3 shows the dose-response curve (n=2) for IC50 determination of thebesylate salt of the present invention for wild-type FLT3. The activityof the besylate salt of crenolanib is plotted against the correspondingmolar concentration in log10 scale.

FIG. 4 shows replicates of a first (left) and a second (right) standarddose-response curves for Kd determination of the besylate salt of thepresent invention for FLT3 ITD. The amount of kinase measured by qPCR(signal; y-axis) is plotted against the corresponding crenolanibconcentration in nanomolar in log10 scale (x-axis).

FIGS. 5A and 5B show the replicates of standard dose-response curves forKd determination of the besylate salt of the present invention for (FIG.5A) replicates of a first (left) and a second (right) for FLT3 D835Y and(FIG. 5B) replicates of a first (left) and a second (right) FLT3 D835H.The amount of kinase measured by qPCR (signal; y-axis) is plottedagainst the corresponding crenolanib concentration in nanomolar in log10scale (x-axis). Data points marked with an “x” were not used for Kddetermination.

FIG. 6 shows the dose-response curve (n=2) for IC50 determination of thebesylate salt of the present invention for FLT3 D835Y. The activity ofthe besylate salt of crenolanib is plotted against the correspondingmolar concentration in log10 scale.

DETAILED DESCRIPTION OF THE INVENTION

While the making and using of various embodiments of the presentinvention are discussed in detail below, it should be appreciated thatthe present invention provides many applicable inventive concepts thatcan be embodied in a wide variety of specific contexts. The specificembodiments discussed herein are merely illustrative of specific ways tomake and use the invention and do not delimit the scope of theinvention.

To facilitate the understanding of this invention, a number of terms aredefined below. Terms defined herein have meanings as commonly understoodby a person of ordinary skill in the areas relevant to the presentinvention. Terms such as “a”, “an” and “the” are not intended to referto only a singular entity, but include the general class of which aspecific example may be used for illustration. The terminology herein isused to describe specific embodiments of the invention, but their usagedoes not delimit the invention, except as outlined in the claims.

The present invention comprises the use of the compounds of the presentinvention to inhibit FLT3 kinase activity in a cell or a subject, or totreat disorders related to FLT3 kinase activity or expression in asubject.

In one embodiment to this aspect, the present invention provides amethod for reducing or inhibiting the kinase activity of FLT3 in a cellcomprising the step of contacting the cell with a compound of thepresent invention. The present invention also provides a method forreducing or inhibiting the kinase activity of FLT3 in a subjectcomprising the step of administering a compound of the present inventionto the subject. The present invention further provides a method ofinhibiting cell proliferation in a cell comprising the step ofcontacting the cell with a compound of the present invention.

The term “subject” refers to an animal, such as a mammal or a human, whohas been the object of treatment, observation or experiment.

The term “contacting” refers to the addition of the present invention orpharmaceutically acceptable salt to cells such that the compound istaken up by the cell.

In other embodiments to this aspect, the present invention provides bothprophylactic and therapeutic methods for treating a subject at risk orsusceptible to developing a cell proliferative disorder driven byaberrant kinase activity of FLT3. In one example, the invention providesmethods for preventing a cell proliferative disorder related to FLT3,comprising administration of a prophylactically effective amount of apharmaceutical composition comprising a compound of the presentinvention in a subject. Administration of said prophylactic agent canoccur prior to the manifestation of symptoms characteristic of the FLT3driven cell proliferative disorder, such that a disease or disorder isprevented or, alternatively, delayed in its progression.

The term “prophylactically effective amount” refers to an amount ofactive compound or pharmaceutical salt that inhibits or delays in asubject the onset of a disorder as being sought by a researcher,veterinarian, medical doctor or other clinician.

The term “therapeutically effective amount” as used herein, refers to anamount of active compound or pharmaceutical salt that elicits thebiological or medicinal response in a subject that is being sought by aresearcher, veterinarian, medical doctor or other clinician, whichincludes alleviation of the symptoms of the disease or disorder beingtreated.

Methods for determining therapeutically and prophylactically effectivedoses for pharmaceutical compositions comprising a compound of thepresent invention are known in the art.

As used herein, the term “composition” is intended to encompass aproduct comprising the specified ingredients in the specified amounts,as well as any product which results, directly or indirectly, fromcombinations of the specified ingredients in the specified amounts.

As used herein, the terms “disorder related to FLT3,” or “disordersrelated to FLT3 receptor,” or “disorders related to FLT3 receptortyrosine kinase,” or “FLT3 driven cell proliferative disorder” includesdiseases associated with or implicating FLT3 activity, for example,mutations leading to constitutive activation of FLT3. Examples of“disorders related to FLT3” include disorders resulting from overstimulation of FLT3 due to mutations in FLT3, or disorders resultingfrom abnormally high amount of FLT3 activity due to abnormally highamount of mutations in FLT3. It is known that over-activity of FLT3 hasbeen implicated in the pathogenesis of many diseases, including thefollowing listed cell proliferative disorders, neoplastic disorders andcancers.

The term “cell proliferative disorders” refers to excess cellproliferation of one or more subset of cells in a multicellular organismresulting in harm (i.e. discomfort or decreased life expectancy) to themulticellular organism. Cell proliferative disorders can occur indifferent types of animals and humans. As used herein, “cellproliferative disorders” include neoplastic disorders.

The term “neoplastic disorder” as used herein, refers to a tumorresulting from abnormal or uncontrolled cellular growth. Examples ofneoplastic disorders include, but are not limited to the followingdisorders, for instance: the myeloproliferative disorders, such asthrombocytopenia, essential thrombocytosis (ET), agnogenic myeloidmetaplasia, myelofibrosis (MF), myelofibrosis with myeloid metaplasia(MMM), chronic idiopathic myelofibrosis (UIMF), and polycythemia vera(PV), the cytopenias, and pre-malignant myelodysplastic syndromes;cancers such as glioma cancers, lung cancers, breast cancers, colorectalcancers, prostate cancers, gastric cancers, esophageal cancers, coloncancers, pancreatic cancers, ovarian cancers, and hematologicalmalignancies, including myelodysplasia, multiple myeloma, leukemias, andlymphomas. Examples of hematological malignancies include, for instance,leukemias, lymphomas, Hodgkin's disease, and myeloma. Also, acutelymphocytic leukemia (ALL), acute myeloid leukemia (AML), acutepromyelocytic leukemia (APL), chronic lymphocytic leukemia (CLL),chronic myeloid leukemia (CML), chronic neutrophilic leukemia (CNL),acute undifferentiated leukemia (AUL), anaplastic large-cell lymphoma(ALCL), prolymphocytic leukemia (PML), juvenile myelomonocytic leukemia(JMML), adult T-cell ALL, AML, with trilineage myelodysplasia(AMLITMDS), mixed lineage leukemia (MLL), myelodysplastic syndromes(MDSs), myeloproliferative disorders (MPD), and multiple myeloma (MM).

In a further embodiment, the present invention can be combined withanother therapy as a combination therapy for treating or inhibiting theonset of a cell proliferative disorder related to FLT3 in a subject. Thecombination therapy comprises the administration of a prophylacticallyand therapeutically effective amount of a compound of the presentinvention and one or more other anti-cell proliferation therapiesincluding, but not limited to, chemotherapy and radiation therapy.

In an embodiment of the present invention, a compound of the presentinvention may be administered in combination with chemotherapy. Usedherein, chemotherapy refers to a therapy involving a chemotherapeuticagent. A variety of chemotherapeutic agents may be used in combinationwith the present invention. By way of example only, taxane compounds,specifically docetaxel, is safely administered in combination with acompound of the present invention in a dosage of 75 mg per square meter(mg/m²) of body surface area.

Chemotherapy is known to those skilled in the art. The appropriatedosage and scheme for chemotherapy will be similar to those alreadyemployed in clinical therapies wherein the chemotherapy is delivered incombination with other therapies or used alone.

In another embodiment of the present invention, compounds of the presentinvention may be administered in combination with radiation therapy.Used herein, “radiation therapy” refers to a therapy that comprises theexposure of a subject in need to radiation. Radiation therapy is knownto those skilled in the art. The appropriate dosage and scheme forradiation therapy will be similar to those already employed in clinicaltherapies wherein the radiation therapy is delivered in combination withother therapies or used alone.

In another embodiment of the present invention, the compounds of thepresent invention may be administered in combination with a targetedtherapy. As used herein, “targeted therapy” refers to a therapytargeting a particular class of proteins involved in tumor developmentor oncogenic signaling. For example, tyrosine kinase inhibitors againstvascular endothelial growth factor have been used in treating cancers.

The present invention also includes methods that include the use of asecond pharmaceutical agent in addition to compounds of the presentinvention, the two may be administered simultaneously or sequentially(in either order).

In one embodiment, the present invention therapeutically effectiveamounts of the compound having formula I:

or a pharmaceutically acceptable salt or solvate thereof, in atherapeutically or prophylactically effective amount against aproliferative disease is selected from at least one of a leukemia,myeloma, myeloproliferative disease, myelodysplastic syndrome,idiopathic hypereosinophilic syndrome (HES), bladder cancer, breastcancer, cervical cancer, CNS cancer, colon cancer, esophageal cancer,head and neck cancer, liver cancer, lung cancer, nasopharyngeal cancer,neuroendocrine cancer, ovarian cancer, pancreatic cancer, prostatecancer, renal cancer, salivary gland cancer, small cell lung cancer,skin cancer, stomach cancer, testicular cancer, thyroid cancer, uterinecancer, and hematologic malignancy. Pharmaceutically acceptable saltsincluding hydrochloride, phosphate and lactate are prepared in a mannersimilar to the benzenesulfonate salt and are well known to those ofmoderate skill in the art.

Compounds of the present invention may be administered to a subjectsystemically, for example, orally, intravenously, subcutaneously,intramuscular, intradermal or parenterally. The compounds of the presentinvention can also be administered to a subject locally.

Compounds of the present invention may be formulated for slow-release orfast-release with the objective of maintaining contact of compounds ofthe present invention with targeted tissues for a desired range of time.

Compositions suitable for oral administration include solid forms, suchas pills, tablets, caplets, capsules, granules, and powders, liquidforms, such as solutions, emulsions, and suspensions. Forms useful forparenteral administration include sterile solutions, emulsions andsuspensions.

The daily dosage of the compounds of the present invention may be variedover a wide range from 15 to 500, 25 to 450, 50 to 400, 100 to 350, 150to 300, 200 to 250, 15, 25, 50, 75, 100, 150, 200, 250, 300, 400, 450,or 500 mg per day. The compounds of the present invention may beadministered on a daily regimen, once, twice, three or more times perday. Optimal doses to be administered may be determined by those skilledin the art, and will vary with the compound of the present inventionused, the mode of administration, the time of administration, thestrength of the preparation, the details of the disease condition. Oneor more factors associated with subject characteristics, such as age,weight, and diet will call for dosage adjustments. Techniques andcompositions for making useful dosage forms using the Crenolanib aredescribed in one or more of the following references: Anderson, Philip0.; Knoben, James E.; Troutman, William G, eds., Handbook of ClinicalDrug Data, Tenth Edition, McGraw-Hill, 2002; Pratt and Taylor, eds.,Principles of Drug Action, Third Edition, Churchill Livingston, NewYork, 1990; Katzung, ed., Basic and Clinical Pharmacology, NinthEdition, McGraw Hill, 20037ybg; Goodman and Gilman, eds., ThePharmacological Basis of Therapeutics, Tenth Edition, McGraw Hill, 2001;Remingtons Pharmaceutical Sciences, 20th Ed., Lippincott Williams &Wilkins., 2000; Martindale, The Extra Pharmacopoeia, Thirty-SecondEdition (The Pharmaceutical Press, London, 1999); relevant portionsincorporated herein by reference.

A dosage unit for use of Crenolanib, may be a single compound ormixtures thereof with other compounds, e.g., a potentiator. Thecompounds may be mixed together, form ionic or even covalent bonds. Thecompounds of the present invention may be administered in oral,intravenous (bolus or infusion), intraperitoneal, subcutaneous, orintramuscular form, all using dosage forms well known to those ofordinary skill in the pharmaceutical arts. Depending on the particularlocation or method of delivery, different dosage forms, e.g., tablets,capsules, pills, powders, granules, elixirs, tinctures, suspensions,syrups, and emulsions may be used to provide the compounds of thepresent invention to a patient in need of therapy that includes thecompound of Formula I.

The Crenolanib is typically administered in admixture with suitablepharmaceutical salts, buffers, diluents, extenders, excipients and/orcarriers (collectively referred to herein as a pharmaceuticallyacceptable carrier or carrier materials) selected based on the intendedform of administration and as consistent with conventionalpharmaceutical practices. Depending on the best location foradministration, the Crenolanib may be formulated to provide, e.g.,maximum and/or consistent dosing for the particular form for oral,rectal, topical, intravenous injection or parenteral administration.While the Crenolanib may be administered alone, it will generally beprovided in a stable salt form mixed with a pharmaceutically acceptablecarrier. The carrier may be solid or liquid, depending on the typeand/or location of administration selected. Preparation of the compoundsof the present invention. General synthetic methods which may bereferred to for preparing the compounds of formula I are provided inU.S. Pat. No. 5,990,146 (issued Nov. 23, 1999) (Warner-Lambert Co.) andPCT published application numbers WO 99/16755 (published Apr. 8, 1999)(Merck & Co.) WO 01/40217 (published Jul. 7, 2001) (Pfizer, Inc.), USPatent Application Publication No. US 2005/0124599 (Pfizer, Inc.) andU.S. Pat. No. 7,183,414 (Pfizer, Inc.), relevant portions incorporatedherein by reference.

Pharmaceutically acceptable salts such as hydrochloride, phosphate andlactate are prepared in a manner similar to the benzenesulfonate saltand are well known to those of moderate skill in the art. The followingrepresentative compounds of the present invention are for exemplarypurposes only and are in no way meant to limit the invention, includingCrenolanib as Crenolanib Besylate, Crenolanib Phosphate, CrenolanibLactate, Crenolanib Hydrochloride, Crenolanib Citrate, CrenolanibAcetate, Crenolanib Toluenesulphonate and Crenolanib Succinate.

Biological Activity.

In Vitro Assays. The following representative in vitro assays wereperformed in determining the FLT3 biological activity of the presentinvention. These are given to illustrate the invention in a non-limitingfashion.

Inhibition of wild type and mutated FLT3 enzyme activity and specificityfor the inhibition of the phosphorylated form of FLT3 exemplify thespecific inhibition of the FLT3 enzyme and cellular processes that aredependent on FLT3 activity. All of the examples herein show significantand specific inhibition of the FLT3 kinase and FLT3-dependent cellularresponses.

Competitive binding assay. Inhibition of the kinase domain of the humanFLT3 receptor was performed using the KINOMEscan KdElect assay protocol.The KINOMEscan platform utilizes a high-throughput competitive bindingtechnology. The assay was performed by combining DNA-tagged kinase,immobilized ligand, and the present invention. The ability of thepresent invention to compete with immobilized ligand was measured usingquantitative PCR of the DNA tag. The competition binding assay was usedto evaluate the present invention against a panel of 96 human proteinkinases.

Kinase-tagged T7 phage strains were grown in parallel in 24-well blocksin an E.coli host derived from the BL21 strain. E. coli were grown tolog phase and infected with T7 phage from a frozen stock and incubatedwith shaking at 32 degrees Celsius until lysis. The lysates were thencentrifuged and filtered. The remaining kinases were produced in HEK-293cells and tagged with DNA for quantitative PCR detection. Affinityresins for the kinase assay were generated by treatingstreptavidin-coated magnetic beads with biotinylated small moleculeligands for 30 minutes at room temperature. The liganded beads wereblocked with excess biotin and washed with blocking buffer consisting ofSea Block, 1% Bovine Serum Albumin (BSA) 0.05% Tween 20, 1 mMDithithreitol (DTT) in order to reduce non-specific phage binding. An11-point 3-fold serial dilution of the present invention was prepared asa 40x stock in 100% Dimethyl sulfoxide (DMSO) and diluted to lx directlyinto the assay.

Binding reactions were initiated by combining the liganded affinitybeads, kinases, and the present invention in lx binding bufferconsisting of 20% Sea Block, 0.17 Phosphate Buffered Saline (PBS), 0.05%Tween 20, 6 mM DTT. All reactions were performed in polypropylene384-well plates in a final volume of 0.04 mL. The plates were incubatedfor 1 hour while shaking at room temperature. The affinity beads werewashed with lx PBS and 0.05% Tween 20 buffer, then re-suspended inelution buffer consisting of 1×PBS, 0.05% Tween 20, 0.5 uMnon-biotinylated affinity ligand. Following re-suspension, the affinitybeads were incubated at room temperature with shaking. The elutantkinase concentration was then measured by quantitative PCR.

Binding constants (Kds) were calculated with a standard dose-responsecurve using the Hill equation. Curves were fitted using a non-linearleast square fit with the Levenberg-Marquardt algorithm. Kds of thepresent invention were compared to both a negative DMSO control and apositive control compound. The binding affinity of the present inventionwas visualized using the compound profile visualization interaction map,TREEspot.

Direct enzyme phosphorylation assay. The Millipore Kinase IC50 Profilerassay was used to screen the present invention against a panel of normalFLT3 and mutated FLT3 kinases. For assays of both kinases, the FLT3enzyme was incubated with 8 mM of 3-(N-morpholino)propanesulfonic acid(MOPS) at a pH of 7.0, 0.2 mM Ethylenediaminetetraacetic acid (EDTA), 50uM, a synthetic Abl peptide substrate EAIYAAPFAKKK, 10 mM MgAcetate and[γ-³³P-ATP]. The reaction was initiated by the addition of MgATp mix.The reaction mixture was incubated for 40 minutes at room temperatureand halted by the addition of 3% phosphoric acid solution. 10 uL of thereaction solution was spotted on P30 filtermat and washed three times in75 mM phosphoric acid for 5 minutes and then once in methanol prior todrying and scintillation counting. The scintillation values for eachreplicate, including positive and negative controls, were analyzed usingXLFit version 5.1 to determine the IC50 values for the present inventionagainst normal and mutated FLT3.

Biological data for phosphorylated kinase affinity.

Analysis of the affinity of the besylate salt of the present inventionfor phosphorylated and non-phosphorylated kinases, ABL1 and ABL(T315I),demonstrates that crenolanib besylate exhibits the characteristicmechanism of a type I inhibitor (FIGS. 1A to 1D). The binding constantsfor phosphorylated ABL1 (Kd=88 nM) and ABL(T3151) (Kd=760 nM) for thepresent invention were 7 and 15-fold lower than its binding constantsfor non-phosphorylated ABL1 (Kd=600 nM) and ABL(T3151) (Kd=12000 nM),respectively (Table 1). Though the present invention is not activeagainst ABL, the besylate salt of the invention has significantlygreater affinity for the phosphorylated kinase which suggests thatcrenolanib is a type I TKI.

TABLE 1 Crenolanib besylate is a type I TKI with increased affinity forphosphorylated kinases. Kinase Target Crenolanib Besylate Kd ABL1(T315I)nonphosphorylated 12000 nM ABL1(T315I) phosphorylated 760 nMABL1-nonphosphorylated 600 nM ABL1-phosphorylated 88 nM

The difference in binding affinities of the besylate salt of the presentinvention for the non-autoinhibited and autoinhibited states of FLT3also indicate that the molecule functions as a type I inhibitor. Asshown in FIGS. 2A and 2B and Table 2, the besylate salt of the presentinvention has a Kd value of 0.61 nM for non-autoinhibited FLT3 and a Kdvalue of 6.7 nM for autoinhibited FLT3. The besylate salt of the presentinvention thus has an approximately 10-fold affinity shift between thenon-autoinhibited and autoinhibited states of FLT3. This value is withinthe range of affinity shifts reported for other type I tyrosine kinaseinhibitors and is far outside the range of 100- to 1000-fold affinityshifts reported for type II TKIs. See Davis, MI et al., Comprehensiveanalysis of kinase inhibitor selectivity. Nat Biotechnology. 2011; 29(10): 1046-1051; Zhang, J et al., Targeting cancer with small moleculekinase inhibitors. Nat Rev Cancer. 2009; 9(1): 28-39; Liu, Y et al.,Rational design of inhibitors that bind to inactive kinaseconformations. Nat Chem Biol. 2006; 2(7): 358-364.

TABLE 2 Crenolanib besylate is a type I TKI with increased affinity forphosphorylated FLT3. Kinase Target Crenolanib Besylate Kd FLT3phosphorylated 0.61 nM FLT3 nonphosphorylated 6.7 nM

Biological data for wild type FLT3.

Crenolanib besylate has demonstrated activity as a specific and potentinhibitor of class III receptor RTKs. TheK_(d) of crenolanib against thewild-type receptors FLT3, PDGFRB, and PDGFRA, PDGFRB, and FLT3 is 0.74nM, 2.1 nM, and 3.2 nM, respectively (Table 3).

TABLE 3 Specificity of the besylate salt of the present invention forclass III receptor tyrosine kinases including FLT3, PDGFRA, and PDGFRB.RTK Binding Constant (Kd) FLT3 wild type 0.74 nM PDGFRB wild type 2.1 nMPDGFRA wild type 3.2 nM

Crenolanib besylate does not inhibit any other known RTKs (e.g. VEGFR,FGFR) or other serine/threonine kinases (e.g. Abl, Raf) at clinicallyachievable concentrations. Crenolanib besylate is 300- to >5000-foldselective relative to concentrations required to inhibit otherangiogenic kinases, VEGFR-2, FGFR-2, and TIE-2 (Table 4). Crenolanibbesylate is >100-fold selective relative to concentrations required toinhibit a variety of other kinases involved in the angiogenesis cascade,such as VEGFR, FGFR as well as other kinases like EGFR, erbB2, src etc.

TABLE 4 Lack of inhibition of the besylate salt of the present inventionfor other RTKs known in the art. RTK IC50 (ng/mL) VEGFR-2 121FGFR-2 >2250 TIE-2 >2250 Src 2208 EGFR >4435 erbB2 >4435

The affinity of the besylate salt of the present invention for wild typeFLT3 is presented in Table 5. All binding constants are presented innanomolar concentration. The binding affinity (Kd) of the besylate saltof the present invention for wild type FLT3 is 0.74 nM.

The affinity of the besylate salt of the present invention is thehighest for wild type FLT3 when compared to a number of other FLT3 TKIsinhibitors known in the art.

TABLE 5 Binding constants (Kd) of the besylate salt of the presentinvention compared to other FLT3 TKIs known in the art for wild typeFLT3. RTK Compound Binding Constant (Kd) FLT3 wild type CrenolanibBesylate 0.74M AST-487 0.79M Quizartinib/AC220 1.3 nM Tandutinib/MLN-5183 nM Lestaurtinib/CEP-701 8.5 nM Midostaurin/PKC-412 13 nM

The activity of the besylate salt of the present invention for FLT3 wildtype was determined using a direct enzymatic Millipore IC50 profilerassay. In the direct enzymatic measurement assay, the IC50 of thebesylate salt of the current invention against wild type FLT3 was 3 nM(FIG. 3 and Table 6).

TABLE 6 Potency of the besylate salt of the present invention againstFLT3 wild type as measured by direct enzymatic phosphorylation. RTKCompound IC50 FLT3 wild type Crenolanib Besylate 3 nM

Biological data for the FLT3-ITD mutation.

The affinity of the besylate salt of the present invention for FLT3 withan ITD mutation is presented in Table 8. All binding constants arepresented in nanomolar concentration. The Kd of the besylate salt of thepresent invention for FLT3-ITD is 0.43 Nm (FIG. 4 ). The affinity of thebesylate salt of the present invention is the highest for mutantFLT3-ITD when compared to a number of other FLT3 TKIs inhibitors knownin the art. A portion of this data and the basic techniques formeasuring the affinities were published by the present inventors, seeMuralidhara C, Ramachandran A, Jain V. Crenolanib, a novel type I,mutant-specific inhibitor of class III receptor tyrosine kinases,preferentially binds to phosphorylated kinases. Cancer Research. 2012;72 (8 Supplement): 3683.

TABLE 8 Binding constants (Kd) of the besylate salt of the presentinvention compared to other FLT3 TKIs known in the art for FLT3-ITD. RTKCompound Binding Constant (Kd) FLT3 ITD Crenolanib besylate 0.43 nMSunitinib 0.99 nM Lestaurtinib/CEP-701 1.5 nM Quizartinib/AC220 8.8 nMTandutinib/MLN-518 9.1 nM Midostaurin/PKC-412 11 nM AST-487 11 nMSorafenib 79 nM

Biological data for the FLT3-D835 mutation.

The activity of the besylate salt of the present invention against FLT3tyrosine kinase domain mutations D835Yand D835H is compared againstother inhibitors known in the art (Table 11). All binding constants arepresented in nanomolar concentration. The Kd of the besylate salt of thepresent invention for the FLT3 D835Y and D835H mutations is 0.18 nM and0.26 nM, respectively (FIGS. 5A and 5B, respectively). The affinity ofthe besylate salt of the present invention is the highest for FLT3 D835Yand FLT3 D835H mutations when compared to a number of other FLT3 TKIsinhibitors known in the art. See Muralidhara C, Ramachandran A, Jain V.Crenolanib, a novel type I, mutant-specific inhibitor of class IIIreceptor tyrosine kinases, preferentially binds to phosphorylatedkinases. Cancer Research. 2012; 72 (8 Supplement): 3683, by the presentinventors.

TABLE 11 Binding constants (Kd) of the besylate salt of the presentinvention compared to other FLT3 TKIs known in the art for FLT3 D835Yand FLT3 D835H. Binding Constant (Kd) RTK Compound FLT3 D835Y FLT3 D835HFLT3 D835 Crenolanib Besylate 0.18 nM 0.4 nM Lestaurtinib 0.57 nM 0.66nM Sunitinib 2.3 nM 4.3 nM AC220 7.1 nM 3.7 nM AST-487 11 nM 4.9 nMPKC-412 15 nM 6.8 nM Sorafenib 82 nM 30 nM

The activity of the besylate salt of the present invention wasdetermined using a direct enzymatic Millipore IC50 profiler assay (Table12). All IC50 values are presented in nanomolar concentration. In thedirect enzymatic measurement assay, the IC50 of the besylate salt of thecurrent invention against the FLT3 TKD mutation D835Y was 2 nM (FIG. 6).

TABLE 12 Potency of the besylate salt of the present invention againstFLT3 D835Y as measured by direct enzymatic phosphorylation. RTK CompoundBinding Affinity (Kd) FLT3 D835Y Crenolanib Besylate 2 nM

Additional biological data supporting the present invention waspublished by investigators from two academic centers working incollaboration with the present inventors. Briefly, the supporting datapertains to the biological activity of the besylate salt of the presentinvention for FLT3 wildtype, FLT3-ITD mutation, FLT3 D835 mutation, dualFLT3-ITD/FLT3-D835 mutation, Type I FLT3 TKI crenolanib besylateovercoming resistance associated with a Type II FLT3TKI, and combiningthe besylate salt of the present invention with cytotoxic chemotherapy.See Galanis A, Rajkhowa T, Muralidhara C, et al. Crenolanib: A nextgeneration FLT3 inhibitor. Cancer Research. 2012; 72(8 Supplement):3660; See Galanis A, Rajkhowa T, Ramachandran A, et al. Crenolanib is ahighly potent, selective, FLT3 TKI with activity against D835 mutations.Blood. 2012; 120: 1341; See Zimmerman E, Hu S, Li L, et al. Evaluationof crenolanib (CP-868,596) for the treatment of FLT3-ITD positive AML.European Journal of Cancer. 2012; 48 (Supplement 6): 38.

Biological data for wild type FLT3.

The potency of the besylate salt of the present invention for FLT3 wildtype was determined in the FLT3 wild type specific cell line SEMK2(Table 7). Crenolanib besylate inhibited the phosphorylation of the wildtype FLT3 receptor in SEMK2 cells at a nanomolar IC50 concentration of2.2 nM. See Galanis A, Rajkhowa T, Muralidhara C, et al. Crenolanib: Anext generation FLT3 inhibitor. Cancer Research. 2012; 72(8 Supplement):3660.

Crenolanib besylate inhibition of phosphorylation of the wild typereceptor was evaluated in the wild type cell line HL60. The inhibitionlevels of crenolanib besylate against the wild type FLT3 receptor cellline was compared to the potency of another FLT3 inhibitor in the art,sorafenib. Crenolanib besylate and sorafenib exhibit increasedphosphorylation inhibition in a dose dependent fashion. Crenolanibbesylate is a more potent inhibitor of FLT3 wild type phosphorylationthan sorafenib. See Galanis A, Rajkhowa T, Muralidhara C, et al.Crenolanib: A next generation FLT3 inhibitor. Cancer Research. 2012;72(8 Supplement): 3660.

Biological data for the FLT3-ITD mutation.

The ability of the besylate salt of the present invention to inhibitphosphorylated FLT3 in cell lines expressing FLT3 ITD, including MV-411,Molm 14, and Molm 13, was examined by western blot. Crenolanib besylateinhibited the phosphorylation of the FLT3-ITD receptor in the cell linesat nanomolar IC50 concentrations of 1.28 nM 2.65 nM, and 4.9 nM,respectively (Table 9). See Galanis A, Rajkhowa T, Muralidhara C, et al.Crenolanib: A next generation FLT3 inhibitor. Cancer Research. 2012;72(8 Supplement): 3660.

TABLE 9 Potency of the besylate salt of the present invention againstFLT3 ITD as measured by phosphorylation inhibition in FLT3 ITD celllines MV-411, Molm 14, and Molm 13. RTK Cell Line IC50 FLT3-ITD MV-4111.28 nM Molm 14 2.65 Molm 13 4.9 nM

The ability of crenolanib besylate to induce apoptosis in FLT3 ITDexpressing Molm 14 cells was compared to that of sorafenib, another FLT3inhibitor known in the art, via an Annexin V/Propidium iodide stainingassay. The cytotoxic response of the Molm 14 cells to crenolanibbesylate was significantly higher as compared to sorafenib (Table 10) atconcentrations 20 nM to 100 nM. See Galanis A, Rajkhowa T, RamachandranA, et al. Crenolanib is a highly potent, selective, FLT3 TKI withactivity against D835 mutations. Blood. 2012; 120: 1341.

TABLE 10 Crenolanib besylate induces significantly greater apoptosis inFLT3 ITD expressing cell line Molm 14 than sorafenib, another FLT3inhibitor known in the art. Percent Apoptosis Compound ConcentrationCrenolanib Sorafenib 20 nM 32.79% 13.07% 50 nM 44.99% 30.21% 100 nM 51.17% 44.09%

The ability of crenolanib besylate to inhibit FLT3 ITD signalling inprimary AML patient blast samples was determined via MTT assay. Samplesfrom five patients harboring the FLT3 ITD mutation were treated withincreasing concentrations of crenolanib besylate. Cytotoxicity wasobserved in a dose dependent fashion. See Galanis A, Rajkhowa T,Muralidhara C, et al. Crenolanib: A next generation FLT3 inhibitor.Cancer Research. 2012; 72(8 Supplement): 3660.

The in vivo anti-leukemic effect of crenolanib besylate was determinedusing a MV-411FLT3-ITD positive AML xenograft mouse model. Ten daysafter tail vein injection of luciferase-expressing MV-411 cells,crenolanib besylate or vehicle was administered at a dose of 15 mg/kgintraperitoneally to male NSG mice twice daily for two days followed byonce daily for 2 days. As depicted in, crenolanib treatmentsiginificantly suppressed MV-411-luciferase bone marrow infiltrationcompared to vehicle treated animals (p<0.01). See Zimmerman E, Hu S, LiL, et al. Evaluation of crenolanib (CP-868,596) for the treatment ofFLT3-ITD positive AML. European Journal of Cancer. 2012; 48 (Supplement6): 386. Biological data for the FLT3-D835 mutation.

The activity of crenolanib besylate was tested against Ba/F3 cells withD835Y and D835N mutations. Crenolanib potently decreased the viabilityof Ba/F3 expressing D835Y and D835N, with IC50 values of 6.38 and 3.93nM, respectively (Table 13). The sensitivity of crenolanib besylate wassuperior to that of AC220 treatment for Ba/F3 D835Y and similar forBa/F3 D835N.

TABLE 13 Potency of the besylate salt of the present invention comparedto AC220, another FLT3 TKI known in the art, against FLT3 D835Y and FLT3D835N. Cell line Crenolanib IC50 pFLT3 AC220 IC50 pFLT3 Ba/F3 D835Y 6.38nM 26.3 nM Ba/F3 D835N 3.93 nM 2.36 nM

The ability of crenolanib besylate to inhibit FLT3 D835V signaling in aprimary AML patient blast sample was determined via western blot and MTTassay. The sample was taken from a 77 yearr old male with a chronicmyeloproliferative disease that developed AML. The AML cells were notedto have a FLT3 D835 mutation. Western blot analysis of the patient blatsincubated in vitro with crenolanid showed inhiition with n IC50 of 2 nM.Sorafenib, another FLT3 inhibitor known in the art, at 20 nM wasineffective at inhibiting FLT3 in the blast cells. The blasts showed agreater cytotoxic response to crenolanib compared with sorafenib in anMTT assay following 3 day exposure. See Galanis A, Rajkhowa T,Ramachandran A, et al. Crenolanib is a highly potent, selective, FLT3TKI with activity against D835 mutations. Blood. 2012; 120: 1341.

Biological data for FLT3-ITD/FLT3-D835 mutation.

The activity of crenolanib besylate was tested against Ba/F3 cells witha double FLT3 D835Y and FLT3 ITD mutation. Crenolanib potently decreasedthe viability of Ba/F3 expressing D835Y/ITD cells with an IC50 value of20.4 nM (Table 14). The sensitivity of crenolanib besylate was superiorto that of AC220 treatment for Ba/F3 D835Y/ITD expressing cells. SeeGalanis A, Rajkhowa T, Muralidhara C, et al. Crenolanib: A nextgeneration FLT3 inhibitor. Cancer Research. 2012; 72(8 Supplement):3660.

TABLE 13 Potency of the besylate salt of the present invention comparedto AC220, another FLT3 TKI known in the art, Ba/F3 cells with a doubleFLT3 D835Y/FLT3 ITD mutation. Cell line Crenolanib IC50 pFLT3 AC220 IC50pFLT3 Ba/F3 D835Y/ITD 20.4 nM 125 nM

Biological data for Type I FLT3 TKI crenolanib besylate overcomingresistance associated with a Type II FLT3TKI.

The ability of crenolanib besylate to inhibit FLT3 D835V signaling in aprimary AML patient blast sample was determined via MTT assay. Thesample was taken from a 53 year old male diagnosed with FLT3 ITD AMLfollowing prior treatment to induction and salvage chemotherapy. He wastreated with AC220, a type II FLT3 inhibitor known in the art, achieveda response, underwent an allogeneic transplant, and then went intoremission. Four months following the transplant, the patient relapsed.The patient then harbored both a FLT3 ITD and FLT3 D835Y mutation. Hisblasts were incubated for 3 days in culture medium with crenolanibbesylate and sorafenib. Crenolanib overcame the type II FLT3 TKIresistance and induced a cytotoxic effect, while sorafenib wasineffective. See Galanis A, Rajkhowa T, Ramachandran A, et al.Crenolanib is a highly potent, selective, FLT3 TKI with activity againstD835 mutations. Blood. 2012; 120: 1341.

Biological data for combining the besylate salt of the present inventionwith cytotoxic chemotherapy.

The effect of crenolanib on nucleoside analogue uptake in AML cells wasevaluated. Cells were incubated for 2 hours with 1.25 uM of radiolabeledcytarabine combined with DMSO control or in combination with crenolanibat 0.1 uM for 5 minutes and 2 hours. Combining cytarabine withcrenolanib in FLT3 wild-type OCI-AML3 cells and FLT3-ITD MV411 cellsshowed that crenolanib does not decrease cytarabine accumulation in AMLcells, despite length of crenolanib incubation time. Synergistic invitro anti-leukemic effects are observed when crenolanib besylate andcytarabine are combined in vitro in MV-411 FLT3 ITD cells.

It is contemplated that any embodiment discussed in this specificationcan be implemented with respect to any method, kit, reagent, orcomposition of the invention, and vice versa. Furthermore, compositionsof the invention can be used to achieve methods of the invention.

It will be understood that particular embodiments described herein areshown by way of illustration and not as limitations of the invention.The principal features of this invention can be employed in variousembodiments without departing from the scope of the invention. Thoseskilled in the art will recognize, or be able to ascertain using no morethan routine experimentation, numerous equivalents to the specificprocedures described herein. Such equivalents are considered to bewithin the scope of this invention and are covered by the claims.

All publications and patent applications mentioned in the specificationare indicative of the level of skill of those skilled in the art towhich this invention pertains. All publications and patent applicationsare herein incorporated by reference to the same extent as if eachindividual publication or patent application was specifically andindividually indicated to be incorporated by reference.

The use of the word “a” or “an” when used in conjunction with the term“comprising” in the claims and/or the specification may mean “one,” butit is also consistent with the meaning of “one or more,” “at least one,”and “one or more than one.” The use of the term “or” in the claims isused to mean “and/or” unless explicitly indicated to refer toalternatives only or the alternatives are mutually exclusive, althoughthe disclosure supports a definition that refers to only alternativesand “and/or.” Throughout this application, the term “about” is used toindicate that a value includes the inherent variation of error for thedevice, the method being employed to determine the value, or thevariation that exists among the study subjects.

As used in this specification and claim(s), the words “comprising” (andany form of comprising, such as “comprise” and “comprises”), “having”(and any form of having, such as “have” and “has”), “including” (and anyform of including, such as “includes” and “include”) or “containing”(and any form of containing, such as “contains” and “contain”) areinclusive or open-ended and do not exclude additional, unrecitedelements or method steps.

The term “or combinations thereof” as used herein refers to allpermutations and combinations of the listed items preceding the term.For example, “A, B, C, or combinations thereof” is intended to includeat least one of: A, B, C, AB, AC, BC, or ABC, and if order is importantin a particular context, also BA, CA, CB, CBA, BCA, ACB, BAC, or CAB.Continuing with this example, expressly included are combinations thatcontain repeats of one or more item or term, such as BB, AAA, AB, BBC,AAABCCCC, CBBAAA, CABABB, and so forth. The skilled artisan willunderstand that typically there is no limit on the number of items orterms in any combination, unless otherwise apparent from the context.

As used herein, words of approximation such as, without limitation,“about”, “substantial” or “substantially” refers to a condition thatwhen so modified is understood to not necessarily be absolute or perfectbut would be considered close enough to those of ordinary skill in theart to warrant designating the condition as being present. The extent towhich the description may vary will depend on how great a change can beinstituted and still have one of ordinary skilled in the art recognizethe modified feature as still having the required characteristics andcapabilities of the unmodified feature. In general, but subject to thepreceding discussion, a numerical value herein that is modified by aword of approximation such as “about” may vary from the stated value byat least ±1, 2, 3, 4, 5, 6, 7, 10, 12 or 15%.

All of the compositions and/or methods disclosed and claimed herein canbe made and executed without undue experimentation in light of thepresent disclosure. While the compositions and methods of this inventionhave been described in terms of preferred embodiments, it will beapparent to those of skill in the art that variations may be applied tothe compositions and/or methods and in the steps or in the sequence ofsteps of the method described herein without departing from the concept,spirit and scope of the invention. All such similar substitutes andmodifications apparent to those skilled in the art are deemed to bewithin the spirit, scope and concept of the invention as defined by theappended claims.

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Stirewalt, D L and J P Radich. The role of FLT3 in hematopoieticmalignancies. Nat Rev Cancer. 2003; 3:650-665.

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S Schnittger, C Schoch and M Duga. Analysis of FLT3 length mutations in1003 patients with acute myeloid leukemia: correlation to cytogenetics,FAB subtype, and prognosis in the AMLCG study and usefulness as a markerfor the detection of minimal residual disease. Blood. 2002; 100:59-66.

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H Kiyoi, T Naoe, Y Nakano, et al. Prognostic implication of FLT3 andN-RAS gene mutations in acute myeloid leukemia. Blood. 1999;93:3074-3080.

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BIOLOGICAL PROCEDURE REFERENCES

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What is claimed is:
 1. A method of inhibiting or reducing deregulatedFLT3 tyrosine kinase activity or expression in a subject with aproliferative disease which comprises administering to the subjecthaving or suspected to have the proliferative disease, a therapeuticallyor prophylactically effective amount of the compound of Formula I:

or a pharmaceutically acceptable salt or solvate thereof, wherein theproliferative disease is selected from at least one of a leukemia,myeloma, myeloproliferative disease, myelodysplastic syndrome,idiopathic hypereosinophilic syndrome (HES), bladder cancer, breastcancer, cervical cancer, CNS cancer, colon cancer, esophageal cancer,head and neck cancer, liver cancer, lung cancer, nasopharyngeal cancer,neuroendocrine cancer, ovarian cancer, pancreatic cancer, prostatecancer, renal cancer, salivary gland cancer, small cell lung cancer,skin cancer, stomach cancer, testicular cancer, thyroid cancer, uterinecancer, and hematologic malignancy.
 2. The method of claim 1, whereinthe therapeutically or prophylactically effective amounts are from about15 to 500, 25 to 450, 50 to 400, 100 to 350, 150 to 300, 200 to 250, 15,25, 50, 75, 100, 150, 200, 250, 300, 400, 450, or 500 mg per day.
 3. Themethod of claim 1, wherein the compound is administered at least one ofcontinuously, intermittently, systemically, or locally.
 4. The method ofclaim 1, wherein deregulated FLT3 is defined further as a mutated FLT3is constitutively active, or is at least one of FLT3-ITD or FLT3-TKD. 5.The method of claim 1, wherein the compound is administered orally,intravenously, or intraperitoneally.
 6. The method of claim 1, whereinthe Crenolanib is at least one of Crenolanib Besylate, CrenolanibPhosphate, Crenolanib Lactate, Crenolanib Hydrochloride, CrenolanibCitrate, Crenolanib Acetate, Crenolanib Toluenesulphonate and CrenolanibSuccinate Crenolanib Besylate.
 7. The method of claim 1, wherein thetherapeutically or prophylactically effective amount of compound isadministered daily for as long as the subject is in need of treatmentfor the proliferative disease.
 8. The method of claim 1, wherein thecompound is provided at least one of: (1) sequentially or concomitantly,with another pharmaceutical agent in a newly diagnosed proliferativedisease subject, to maintain remission of an existing subject, or arelapsed/refractory proliferative disease subject; (2) as a single agentor in combination with another pharmaceutical agent in a newly diagnosedproliferative disease subject, to maintain remission, or arelapsed/refractory proliferative disease subject; (3) as a single agentor in combination with another pharmaceutical agent in a newly diagnosedproliferative disease pediatric subject, to maintain remission, or arelapsed/refractory proliferative disease pediatric.
 9. The method ofclaim 1, further comprising the step of determining if the subject isrelapsed/refractory to a prior FLT3 tyrosine kinase inhibitor.
 10. Amethod for treating a subject with a proliferative disease comprising:administering to the subject in need of such treatment a therapeuticallyeffective amount of Crenolanib or a salt thereof, wherein the cellproliferative disorder is characterized by deregulated FLT3 receptortyrosine kinase activity, proliferative disease is selected from atleast one of a leukemia, myeloma, myeloproliferative disease,myelodysplastic syndrome, idiopathic hypereosinophilic syndrome (HES),bladder cancer, breast cancer, cervical cancer, CNS cancer, coloncancer, esophageal cancer, head and neck cancer, liver cancer, lungcancer, nasopharyngeal cancer, neuroendocrine cancer, ovarian cancer,pancreatic cancer, prostate cancer, renal cancer, salivary gland cancer,small cell lung cancer, skin cancer, stomach cancer, testicular cancer,thyroid cancer, uterine cancer, and hematologic malignancy, and whereinthe subject is refractory to at least one other tyrosine kinaseinhibitor.
 11. The method of claim 10, wherein the compound isadministered orally, intravenously, or intraperitoneally.
 12. The methodof claim 10, wherein the Crenolanib is at least one of CrenolanibBesylate, Crenolanib Phosphate, Crenolanib Lactate, CrenolanibHydrochloride, Crenolanib Citrate, Crenolanib Acetate, CrenolanibTouluenesulphonate and Crenolanib Succinate Crenolanib Besylate.
 13. Themethod of claim 10, wherein the Crenolanib is provided at least one of:(1) sequentially or concomitantly, with chemotherapy, radiotherapy, orsurgery in a newly diagnosed proliferative disease, to maintainremission, or a relapsed/refractory proliferative disease; (2) as asingle agent or in combination with chemotherapy, radiotherapy orsurgery for treatment of pediatric subject with the proliferativedisease; (3) as a single agent to at least one of post standardinduction therapy, or high dose induction therapy, in newly diagnosedproliferative disease; or (4) as a single agent in treatment of subjectswith the proliferative disease that is either refractory to, or hasrelapsed after, standard or high dose chemotherapy, radiotherapy orsurgery.
 14. The method of claim 10, wherein the method furthercomprises the step of identifying a subject in need of treatment for aproliferative disease prior to treatment.
 15. A method for specificallyinhibiting a deregulated receptor tyrosine kinase comprising: obtaininga subject sample and determining which receptor tyrosine kinases arederegulated; and administering to a mammal in need of such treatment atherapeutically effective amount of Crenolanib or a salt thereof,wherein the deregulated receptor tyrosine kinase is a FLT3 receptortyrosine kinase, wherein the proliferative disease is selected from atleast one of a leukemia, myeloma, myeloproliferative disease,myelodysplastic syndrome, idiopathic hypereosinophilic syndrome (HES),bladder cancer, breast cancer, cervical cancer, CNS cancer, coloncancer, esophageal cancer, head and neck cancer, liver cancer, lungcancer, nasopharyngeal cancer, neuroendocrine cancer, ovarian cancer,pancreatic cancer, prostate cancer, renal cancer, salivary gland cancer,small cell lung cancer, skin cancer, stomach cancer, testicular cancer,thyroid cancer, uterine cancer, and hematologic malignancy.
 16. Themethod of claim 15, wherein the therapeutically and prophylacticallyeffective amounts are from about 15 to 500 mg per day.
 17. The method ofclaim 15, wherein the compound is administered at least one ofcontinuously, intermittently, systemically, or locally.
 18. The methodof claim 15, wherein deregulated FLT3 is defined further as a mutatedFLT3 is constitutively active or is at least one of FLT3-ITD orFLT3-TKD.
 19. The method of claim 15, wherein the compound isadministered orally, intravenously, or intraperitoneally.
 20. The methodof claim 15, wherein the Crenolanib is at least one of CrenolanibBesylate, Crenolanib Phosphate, Crenolanib Lactate, CrenolanibHydrochloride, Crenolanib Citrate, Crenolanib Acetate, CrenolanibTouluenesulphonate and Crenolanib Succinate Crenolanib Besylate.
 21. Amethod for treating a subject with a hematological malignancycomprising: obtaining a sample suspected of having cancer from thesubject; determining if the subject that has become resistant to priorFLT3 protein tyrosine kinase inhibition; and administering atherapeutically effective amount of Crenolanib or a salt thereof toovercome the resistance to the prior FLT3 protein tyrosine kinaseinhibition.